Form 3.47	Originating application for costs assessment
Court Procedures Rules 2006
(see r 3621 (Form of application))
In the Supreme Court of the Australian Capital Territory

No SC		of (year) (Court to complete)
Legal Profession Act 2006, section *[294A/295/296]

(name)
Applicant

(name)
Respondent

To: (name of respondent) of (address)
Take notice that the applicant applies for the assessment of legal costs under the Legal Profession Act 2006, division 3.2.7 (Costs assessment).
This application is listed for directions before the registrar on (date) at (time).
There is no reasonable prospect of settlement of this matter by mediation.
Date:
(signature of applicant or applicant’s solicitor)
(name of applicant or applicant’s solicitor)

Documents
This application is supported by the following documents:
*1.	Costs agreement dated (date).
*2.	Retainer dated (date).
3.	Affidavit of (name of applicant) *[sworn/affirmed] on (date).
Applicant
(if the applicant is an individual)
Full name:
*[Home/Business] address:
(if the applicant is a corporation)
Name:
(if the corporation is a company or a registered body within the meaning of the Corporations Act 2001 (Cwlth))
*[Australian Company Number/Australian Registered Body Number]:
Type of body:
Address of *[registered office/public officer]:
*Representative capacity in which applicant sues:
*(if the applicant is represented by a solicitor)
Solicitor’s full name:
(if the solicitor practises in a firm of solicitors)
*Solicitor’s firm:
Solicitor’s full business address:
Solicitor’s telephone no:
*Name, address and telephone no of solicitor’s agent:
Address for service of documents
(set out applicant’s address for service)
(if represented by a solicitor the following information may be given)
*Document exchange box no:
(if postal address different from address for service)
*Postal address:
*Fax:
*Email address:
Respondent 
Full name:
Address for service:

*omit if, or whichever is, inapplicable